Midterm results of mitral valve repair for atrial functional mitral regurgitation: a retrospective study

Abstract

Background Annular dilation by left atrial remodeling is considered the main cause of atrial function mitral regurgitation. Although acceptable outcomes have been obtained using mitral ring annuloplasty alone for atrial functional mitral regurgitation, data assessing outcomes of this procedure are limited. Therefore, we aimed to assess midterm outcomes of mitral valve repair in patients with atrial functional mitral regurgitation. Methods We retrospectively studied 40 patients (mean age: 69 ± 9 years) who had atrial fibrillation that persisted for > 1 year, preserved left ventricular ejection fraction of > 40%, and mitral valve repair for atrial functional mitral regurgitation. The mean clinical follow-up duration was 42 ± 24 months. Results Mitral ring annuloplasty was performed for all patients. Additional repair including anterior mitral leaflet neochordoplasty was performed for 22 patients. Concomitant procedures included maze procedure in 20 patients and tricuspid ring annuloplasty in 31 patients. Follow-up echocardiography showed significant decreases in left atrial dimensions and left ventricular end-diastolic dimensions. Recurrent mitral regurgitation due to ring detachment or leaflet tethering was observed in five patients and was seen more frequently among those with preoperative left ventricular dilatation. Three patients without tricuspid ring annuloplasty or sinus rhythm recovery by maze procedure developed significant tricuspid regurgitation. Five patients who underwent the maze procedure showed sinus rhythm recovery. Rates of freedom from re-admission for heart failure at 1 and 5 years after surgery were 95 and 86%, respectively. Conclusions Mitral valve repair is not sufficient to prevent recurrent atrial functional mitral regurgitation in patients with preoperative left ventricular dilatation. Tricuspid ring annuloplasty may be required for long-term prevention of significant tricuspid regurgitation.

Surgical considerations for atrial functional regurgitation of the mitral and tricuspid valves based on the etiological mechanism

“…We added reinforcement of the rough zone by artificial chordae implantation using the loop technique to the pseudo-prolapsed area to avoid recurrent prolapse [ 23 , 26 ]. Kaneyuki et al reported mid-term results of mitral repair in 40 cases [ 27 ]. They applied artificial chordae replacement to the anterior leaflet for pseudo-prolapse in 19 (19%) patients, and 2 patients developed moderate to severe MR during follow-up.…”

“…In our previous study, we added TAP to all surgical cases of atrial functional MR, even if TR was less than moderate to prevent regurgitation from worsening in the future [ 23 ]. Kaneyuki et al reported that three patients developed moderate or severe recurrent TR during follow-up in five patients without TAP [ 27 ]. These authors suggested that TAP should be performed in addition to mitral valve repair of atrial functional MR. Balogh et al added TAP in 67 (49%) patients, but they did not mention postoperative TR [ 24 ].…”